Current practice in the management of acute cholecystitis

Cameron, IC; Chadwick, Carolyn; Phillips, Jonathan H.; Johnson, A. G.

doi:10.1046/j.1365-2168.2000.01383-13.x

Cited by 16 publications

(18 citation statements)

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“…Only 15-20% of surgeons have adopted the policy of urgent cholecystectomy during the index admission. 29,30 The perceived risk of higher complications (particularly bile duct injury and conversion rates) may be responsible for the unpopularity of early laparoscopic cholecystectomy. Other possible contributory factors could be the delays caused by availability of emergency operating lists and the radiology investigations, which essentially means that the surgeons miss the 'window of opportunity' for surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Urgent Cholecystectomy for Acute Cholecystitis in a District General Hospital – Is it Feasible?

Khan

Nordon

Ghauri

et al. 2009

annals

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Ann R Coll Surg Engl 2009; 91: 30-34 30Laparoscopic cholecystectomy has become the gold standard for treatment of symptomatic gall stone disease. 1 Recently, this has also gained acceptance as the surgical treatment for acute cholecystitis. The traditional teaching has been a two-stage treatment for acute cholecystitis with an initial conservative management followed by an interval laparoscopic cholecystectomy.2 This has been based on the experience of increased conversion and complication rate with early cholecystectomy in acute cholecystitis which overshadow all the advantages of the laparoscopic approach making this inefficient and unsafe. 3 The conversion rates for elective laparoscopic cholecystectomy range from 3-7%. 4,5 However, in the presence of acute inflammation, higher conversion rates of up to 30% have been reported. 6,7 Timing of surgery in acute cholecystitis has been controversial. Several studies have reported favourable outcomes with a low conversion rate if patients are operated within 96 h of admission. [8][9][10] After that window period, surgeons have opted for interval cholecystectomy after a period of 6-8 weeks. 8Larger surgical centres have published their successful management of acute cholecystitis with urgent laparoscopic cholecystectomy. 11 We set out to discover if similar outcomes were reproducible in a district general hospital. The aim of this study was to determine the conversion rate and the risk of major complications with laparoscopic cholecystectomy for acute cholecystitis and to compare the results with the published data from specialist centres. However, its place remains controversial in the management of acute cholecystitis due to a high reported incidence of bile leaks and conversion rate. Tertiary referral centres have reported good results. We present a series of cases after the introduction of an urgent cholecystectomy pathway in a district general hospital. PATIENTS AND METHODS A practice of urgent cholecystectomy for acute cholecystitis was introduced by three consultant general surgeons. All prospective patients having an urgent laparoscopic cholecystectomy for acute cholecystitis, over an 8-month period were entered into a database. A dedicated ultrasound service was instituted to provide prompt diagnosis in these patients. Their demographic details, operative findings, laboratory results were recorded in a prospective database. Timing of ERCP, postoperative complications and conversion rate and hospital stay were also noted. RESULTS There were 64 patients in the study with a median age of 51 years (range, 21-84 years). There were 21 males and 43 females. All patients underwent laparoscopic cholecystectomy during the index admission. Eleven patients had pre-operative ERCP and 12 patients had on-table cholangiogram. There were no conversions. Postoperative ERCP was required in six patients. The median time interval between admission and operation was 3 days (range, 2-7 days). There were two bile leaks but no common bile duct injury. There were two cases of superfi...

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Section: Discussionmentioning

confidence: 99%

Urgent Cholecystectomy for Acute Cholecystitis in a District General Hospital – Is it Feasible?

Khan

Nordon

Ghauri

et al. 2009

annals

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“…In a previous postal questionnaire to the general surgeons who were thought to be involved in the general surgical on-call rota, Cameron and colleagues 28 reported that only 12% of the surgeons treated their patients by emergency cholecystectomy whenever possible. In the current survey, the proportion of early operators, albeit higher (20%), has remained low.…”

Section: Management Of Acute Cholecystitismentioning

confidence: 99%

A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK

Senapati¹,

Bhattarcharya²,

Harinath³

et al. 2003

ann r coll surg engl

103

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[306][307][308][309][310][311][312] Audit weeks. This would take the form of a cholecystectomy (and bile duct clearance if necessary) in fit patients and an endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy in the unfit. Indeed the risk of recurrence of acute biliary pancreatitis in the presence of cholelithiasis could be as high as 60% within 6 months. 3Endoscopic sphincterotomy significantly reduces the risk of recurrent acute biliary pancreatitis in unfit patients to 2-5% at 2 years. [4][5][6] In the management of acute cholecystitis, the conventionally adopted approach of conservative treatment and interval cholecystectomy has its distinct disadvantages. Whilst the majority of patients respond to such treatment approach, up to one-fifth of patients fail to do so and require an urgent cholecystectomy. [7][8][9] Moreover, up to one-quarter of patients who have recovered from acute cholecystitis relapse while awaiting an interval cholecystectomy. 7 In a randomised controlled trial of early versus delayed open cholecystectomy for acute cholecystitis some 25 years ago, Lahtinen and colleagues 7 found early surgery to be safe and associated with significantly shorter operating time, and had avoided the complications of failed medical treatment. A number of recent randomised clinical trials have addressed the timing and surgical approach to cholecystectomy in patients with acute cholecystitis, 9-13 and demonstrated that laparoscopic cholecystectomy performed during the index admission with acute cholecystitis was associated with a shorter hospital stay, 9,11-13 quicker recovery, 9 and a reduction in the overall treatment cost when compared with open cholecystectomy during the index admission with acute cholecystitis 12 or interval laparoscopic cholecystectomy. 9,11,13 Moreover, early laparoscopic cholecystectomy was safe, and earlier reports of increased risk of bile duct injuries 14 were not substantiated by more recent experiences. 9,11,13,15 The aims of this study, therefore, were to survey the currently adopted practice of the UK surgeons in the surgical management of acute biliary pancreatitis and acute cholecystitis, to evaluate the impact of various subspecialty interests on the practice adopted, and to suggest pathways towards a better implementation of the guidelines and other evidence-based management approaches. Materials and MethodsThe names and addresses of the practising members of the Association of the Surgeons of Great Britain and Ireland were obtained from the Association's office, and a postal questionnaire was sent to its 1086 current members. The survey included a general questionnaire, as well as a questionnaire that addressed the current practice adopted by each surgeon in relation to the timing and approach to the surgical management of acute biliary pancreatitis and acute cholecystitis (see Appendix). The reply to the questionnaire was anonymous. Statistical analysisThe replies were compiled on a computer database for analysis. Data were analysed using SPS...

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“…The hospital stay was shorter in the early group. In another prospective trial, the conservative treatment failed completely in 14.3% of patients who had to undergo emergency operations and 33% had to be operated earlier than planned [75] .…”

Section: Lc Vs Ocmentioning

confidence: 99%

“…Min et al [73] defi ned it if two or more of the clinical and operative fi ndings were positive: fever 1 37.5 ° C, right upper abdominal pain with tenderness 1 48 h, gallbladder wall 1 4 mm, adhesion to an adjacent organ and infl ammation of the gallbladder serosa [74] . Cameron [75] …”

Section: Current Status Of Laparoscopic Therapy For Acute Cholecystitismentioning

confidence: 99%

Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones

Shamiyeh¹,

Wayand²

2005

Dig Dis

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Background: Laparoscopic cholecystectomy (LC) is the standard operation for gallstone disease. The aim of this review was to scrutinize the advantages and benefits of this minimal invasive technique compared to the conventional operation according to the available literature. Regarding the evidence-based medicine criteria, the current status of laparoscopy in the treatment of cholecystolithiasis, cholecystitis and common bile duct stones has been worked out. Methods: A Medline, PubMed, Cochrane search. Results: Ten randomized controlled trials (RCTs) are available comparing laparoscopic versus open cholecystectomy. The superiority of LC in less postoperative pain, shorter recovery and hospital stay is stated. Operation time was longer in the first years of LC. 3 RCTs deal with acute cholecystitis: one paper could not find any significant advantage of LC over conventional cholecystectomy, the other two found benefits in recovery, hospital stay and postoperative pain. The range of conversion is between 5 and 7% in elective cases and increases up to 27% for acute cholecystitis. With a rate of more than 90% in Europe, the standard procedure for common bile duct stones is ‘therapeutic splitting’ with endoscopy and retrograde cholangiopancreatography preoperatively followed by LC. Laparoscopic bile duct clearance is effective and safe in experienced hands, however, the only proven benefit is a slightly shorter hospital stay. Conclusion: The laparoscopic approach is preferred in elective cholecystectomy and acute cholecystitis. The minimal invasive technique has proven to be effective, gentle and safe. The main benefits are evident within the first postoperative days.

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Current practice in the management of acute cholecystitis

Cited by 16 publications

References 0 publications

Urgent Cholecystectomy for Acute Cholecystitis in a District General Hospital – Is it Feasible?

Urgent Cholecystectomy for Acute Cholecystitis in a District General Hospital – Is it Feasible?

A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK

Current Status of Laparoscopic Therapy of Cholecystolithiasis and Common Bile Duct Stones

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