Early or delayed cholecystectomy in acute cholecystitis? A clinical trial

Norrby, S. Ragnar; Herlin, P.; Holmin, T.; Sjödahl, Rune; Tagesson, Christer

doi:10.1002/bjs.1800700309

Cited by 153 publications

(89 citation statements)

References 12 publications

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“…1998 213 established treatment policy. Approximately 22-27 per cent cases thus treated may be readmitted with acute symptoms in the convalescence period [4]. Three of our cases (11.1 %) were thus treated by ES during their second admission with AC.…”

Section: Discussionmentioning

confidence: 69%

“…Mortality figures rise sharply in the elderly, in whom the incidence of complications when managed conservatively is also high [4]. Most of our patients with acute cholecystitis, unlike the west, are not elderly.…”

Section: Discussionmentioning

confidence: 81%

“…However one needs to be cautious in handling inflamed friable tissues, anatomical distortions and an oozy operating field [4,5]. Bile duct exploration and pre-operative cholangiography can be done wherever indicated without influencing the outcome of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Most surgeons in India wait 6-8 weeks before performing cholecystectomyon a patient with acute cholecystitis [2]. Several studies have established the virtue of early cholecystectomy [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Acute Cholecystitis – Early or Delayed Surgery

Kannan³

et al. 1998

Medical Journal Armed Forces India

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A comparative study of early vs delayed cholecystectomy was conducted on 51 patients who presented with acute cholecystitis. Ultrasonography was accurate in diagnosing all cases of acute cholecystitis. Twenty four patients were managed by early surgery performed between 24 and 72 hours of onset of symptoms. Twenty seven were managed by delayed cholecystectomy between 8 weeks and 6 months of the acute episode. Early surgery required a longer operating time (120 +/-15 minutes vs 90 +/-15 minutes), more skill and had a marginally higher operative blood loss (150 vs 100mI). Early surgery did not alter the decision or outcome of bile duct exploration. There were no fatalities or major complications. The total hospital stay was reduced in the early surgery group (10 vs 18 days). The study confirms the advantage of early cholecystecto~yfor treatment of acute cholecystitis.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Cholecystitis – Early or Delayed Surgery

Kannan³

et al. 1998

Medical Journal Armed Forces India

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“…Many authors show that early stage cholecystectomy in patients with acute cholecystitis is better than conservative treatment and results in lower patient morbidity and hospital costs, even with open surgery [8][9][10][11][12][13][14]. In spite of the scientific evidence, it is not a common practice.…”

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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