Evaluation of the management of acute cholecystitis

Ra, Payne

doi:10.1002/bjs.1800560311

Cited by 21 publications

(11 citation statements)

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“…Smith and Sherlock (1964) pointed out that difficulty at delayed surgery after a severe attack of acute cholecystitis is accepted by the surgeon though in fact if the operation had been done earlier it might have been found easier. In Payne's (1969) series of 398 patients with acute cholecystitis operation was performed within a few hours of admission in one-third of the cases without mortality. Smiddy (1970) undertook emergency cholecystectomy on the day of admission in IOO consecutive patients with clear-cut acute cholecystitis who were considered to be fit for surgery, and there were 3 deaths; these occurred in patients with a mean age of 75 years.…”

Section: Discussionmentioning

confidence: 99%

“…This view is based on the premiss that operation during the acute phase may be difficult or even dangerous; as a policy it succeeds in that the resulting mortality is generally low. Nevertheless, the timing of operation remains controversial and many have argued that early definitive operation without planned delay will avoid a waiting period, which is not entirely free from further painful attacks, and allow the patient to resume a normal life sooner; if operation is carried out in the first few days symptoms are at once abolished and further spread of inflammation beyond the gall-bladder is prevented (Devine, 1940;Glen and Thorbjarnson, 1963;Smith and Sherlock, 1964;Essenhigh, 1966;Payne, 1969; Van der Linden and Sunzel, 1970). It cannot be denied that these are strong arguments against delay.The management of our own patients has been based on a conservative policy.…”

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confidence: 99%

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Early and delayed operation in acute gall-stone disease

Sokhi

Longland

1973

Journal of British Surgery

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SUMMARYIn a review of 157 patients admitted to hospital as emergencies with acute gall-stone disease it was found that 52 cases (33.1 per cent) had undergone definitive operation for gall-stones during the emergency admission in spite of an overall conservative policy in relation to operation. The results of these early operations are compared with those of operations delayed to a second admission in other patients of this series. There was no significant difference in mortality or morbidity, but there was a saving on average of 5 days in hospital for those patients who were operated on at the first admission.THE clinical manifestations of gall-stones can properly be referred to as 'gall-stone disease'; in this account we confine ourselves to manifestations arising in the biliary tract, thereby excluding the extra-biliary complications of pancreatitis and gall-stone ileus.In the management of any acute episode of gallstone disease conservative treatment is commonly preferred, no matter whether inflammatory or mechanical factors predominate. The policy of conservatism, aimed primarily at inflammatory disease, derives from the early part of this century and has been described as reserving surgical intervention within the first few days for uncertain diagnosis or uncontrolled infection (Till, 1963); acute symptoms usually subside, and operation necessary to deal with stones is planned as a delayed elective procedure at a later date. This view is based on the premiss that operation during the acute phase may be difficult or even dangerous; as a policy it succeeds in that the resulting mortality is generally low. Nevertheless, the timing of operation remains controversial and many have argued that early definitive operation without planned delay will avoid a waiting period, which is not entirely free from further painful attacks, and allow the patient to resume a normal life sooner; if operation is carried out in the first few days symptoms are at once abolished and further spread of inflammation beyond the gall-bladder is prevented (Devine, 1940;Glen and Thorbjarnson, 1963;Smith and Sherlock, 1964;Essenhigh, 1966;Payne, 1969; Van der Linden and Sunzel, 1970). It cannot be denied that these are strong arguments against delay.The management of our own patients has been based on a conservative policy. Even so, considerable numbers of patients for various reasons have had early operation, defined here as operation during the emergency admission. We have compared the results in these patients with the results in those treated conservatively followed by delayed operation at a later admission in a group of patients all of whom were admitted initially as emergencies. If early operation is fraught with difficulties its results might be expected to compare poorly with delayed operation when a conservative policy is in operation, because patients selected for early operation will tend to be those in whom the disease is worse and has failed to respond to conservative management. It is not intended to suggest that all cases of ac...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Early and delayed operation in acute gall-stone disease

Sokhi

Longland

1973

Journal of British Surgery

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“…(1969) reports no deaths in a series of 133 patients with acute cholecystitis treated by early cholecystectomy. Several authors have stressed the mortality rate associated with conservative management (Essenhigh, 1966 ;Rosi and Midell, 1967;Payne, 1969). Burnett (1971) reported one death in zoo patients 26 managed conservatively initially, though 53 patients subsequently had early cholecystectomy.…”

Section: Morbiditymentioning

confidence: 99%

“…There is a theoretical criticism of early operation in that the patient may not have further attacks of cholecystitis, so that the operation may be unnecessary. Payne (1969) points out that the data available on the recurrence rate of acute cholecystitis are scanty. Rosi and Midell (1967) report a recurrence rate of 597% within six years.…”

Section: Pfieils Et Altimentioning

confidence: 99%

Acute Cholecystitis: The Question of Early or Late Operation

Pheils

Andersen

Silverton

et al. 1973

Australian and New Zealand Journal of Surgery

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During the five‐year period from 1963 to 1968 there were 327 elective cholecystectomies, and 128 cholecystectomies carried out during an attack of acute cholecystitis. The patients in the acute group were significantly older than those in the elective group. The operative mortality was 1.2% in the elective group and 1.6% in the acute group. The only significant difference in the incidence of complications was that temporary biliary fistula which occurred only in the acute group.

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“…Other potentially dangerous conditions, i.e., perforated duodenal ulcer or high subhepatic appendicitis misdiagnosed as acute cholecystitis are treated without delay. 4,8 3. The risks of complications such as perforated gallbladder are diminished.…”

Section: Introductionmentioning

confidence: 99%

Early Versus Delayed Surgery for Acute Cholecystitis

Al-Khuwaitir

1985

Ann Saudi Med

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There are those who advocate traditional management for patients with acute cholecystitis (initial conservative treatment followed two to three months later by elective cholecystectomy) and those who favor a more aggressive surgical approach (early cholecystectomy, within 7 days of admission). This retrospective study was designed to see which is more efficient. Such variables as difficulty of operation, incidence of complications, frequency of diagnostic error, and time spent in the hospital were studied in 100 patients, 46 of whom had early and 54 delayed cholecystectomy. No significant differences were found in the two groups in postoperative mortality or morbidity, diagnostic error, or technical difficulty. The most striking difference was found in time spent in the hospital. The total hospital stay was 8.5 days higher in the traditionally delayed surgery group than in the early surgery group; thus it is probably more desirable to have a surgeon, thoroughly familiar with the operation, perform early cholecystectomy.SA Al-Khuwaitir, Early Versus Delayed Surgery for Acute Cholecystitis. 1985; 5(2): 63-66

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Evaluation of the management of acute cholecystitis

Cited by 21 publications

References 9 publications

Early and delayed operation in acute gall-stone disease

Early and delayed operation in acute gall-stone disease

Acute Cholecystitis: The Question of Early or Late Operation

Early Versus Delayed Surgery for Acute Cholecystitis

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