Index cholecystectomy in grade <scp>II</scp> and <scp>III</scp> acute calculous cholecystitis is feasible and safe

Kamalapurkar, Deepali; Pang, Tony; Siriwardhane, Mehan; Hollands, Michael; Johnston, Emma; Pleass, Henry; Richardson, A. J.; Lam, Vincent

doi:10.1111/ans.12986

Cited by 34 publications

(31 citation statements)

References 33 publications

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“…On the question of Grade III, two Australian and Singaporean studies have suggested that even Grade III patients can safely undergo surgery . Kamalapurkar et al.…”

Section: Discussionmentioning

confidence: 99%

“…Grade I (mild) comprises cases other than Grades II and III, with lower risk of death and surgical risk that can easily be treated by laparoscopic cholecystectomy (LC). Since the Tokyo Guidelines (TG) have become widely known worldwide, recent multidirectional studies have evaluated the TG13 severity grading criteria for AC . In Tunisia, the spread of the TG has increased the rate of LC, significantly reducing preoperative and total hospital stay without increasing intra‐ and postoperative complications ; in Taiwan, Cheng et al.…”

Section: Introductionmentioning

confidence: 99%

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Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Yokoe

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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Background The collaborative multicenter retrospective study of acute cholecystitis (AC) was performed in Japan and Taiwan. The aim for this study was evaluation of the clinical value of TG13 severity grading for AC. Method The study was designed as an international multicenter retrospective study of AC from 2011 to 2013. Based on the data, we investigated the TG13 severity grading by analyzing the correlations between grade and prognosis, surgical procedures, histopathology, and organ dysfunction and prognosis. Results An investigation revealed that 30-day overall mortality rate was 1.1% for Grade I, 0.8% for Grade II, 5.4% for Grade III. The mortality rate for Grade III was significantly higher than lower grades (P < 0.001). The greater the number of organ dysfunction, the higher the mortality rate (P < 0.001). However, the mortality rate varied depending on the number of organ dysfunction (3.1-25%). With respect to the surgical procedures, laparoscopic cholecystectomy was performed for Grade I patients (P < 0.001), and the higher the grade, the more likely open surgery would be selected (P < 0.001). Conclusion TG13 severity grading criteria for AC are providing great benefits in actual clinical settings. From this study, the position of each severity grade was obviously confirmed.

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“…On the question of Grade III, two Australian and Singaporean studies have suggested that even Grade III patients can safely undergo surgery . Kamalapurkar et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Yokoe

Takada

Hwang

et al. 2017

J Hepato Biliary Pancreat

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“…Analysis of these studies was inadequate to provide recommendations for the use of PC in high-risk patients. Several authors have established the safety and efficacy of early CCY for patients with acute cholecystitis, including high-risk populations [6, 22, 23]. In addition, a recent propensity-matched analysis by Dimou et al [24] found that cholecystostomy tube placement was associated with increased mortality among elderly patients with Grade III cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

“…PC may function as a temporizing measure for patients with calculous cholecystitis, or as definitive therapy for patients with no gallstones who are at low risk for recurrence [1, 2]. Incidence of PC has increased over time despite controversy fueled by the paucity of direct comparisons to CCY and limited prognostic data for outcomes following PC [3–6]. The purposes of this study were to compare outcomes following PC versus CCY and to identify predictors of 30-day and 1-year mortality following PC.…”

mentioning

confidence: 99%

Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy

et al. 2017

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Background Data regarding long-term outcomes following percutaneous cholecystostomy (PC) are limited, and comparisons to cholecystectomy (CCY) are lacking. We hypothesized that chronic disease burden would predict 1-year mortality following PC, and that outcomes following PC and CCY would be similar when controlling for preprocedural risk factors. Methods We performed a 10-year retrospective cohort analysis of patients with acute cholecystitis managed by PC (n = 114) or CCY (n = 234). Treatment response was assessed by systemic inflammatory response syndrome (SIRS) criteria at PC/CCY and 72 h later. Logistic regression identified predictors of 30-day and 1-year mortality following PC. PC and CCY patients were matched by age, Tokyo Guidelines (TG13) cholecystitis severity grade, and VASQIP calculator predicted mortality (n = 42/group). Results The presence of SIRS at 72 h following PC was associated with 30-day mortality [OR 8.9 (95% CI 2.6–30)]. SIRS at 72 h was present in and 21.4% of all PC patients, significantly higher than unmatched CCY patients (4.7%, p = 0.048). Independent predictors of 1-year mortality following PC were DNR status [19.7 (2.1–186)], disseminated cancer [7.5 (2.1–26)], and congestive heart failure [3.9 (1.4–11)]. PC patients with none of these risk factors had 17.9% 90-day mortality and no deaths after 90 days; late deaths continued to occur among patients with DNR, CHF, or disseminated cancer. At baseline, PC patients had greater acute and chronic disease burden than CCY patients. After matching, PC and CCY patients had similar age (69 vs. 70 years), TG13 grade (2.4 vs. 2.4), and predicted 30-day mortality (5.5 vs. 6.8%). Matched PC patients had higher 30-day mortality (14.3 vs. 2.4%, p = 0.109) and 180-day mortality (28.6 vs. 7.1%, p = 0.048). Conclusions Treatment response to PC predicted 30-day mortality; DNR status, and chronic diseases predicted 1-year mortality. Although the matching procedure did not eliminate selection bias, PC was associated with persistent systemic inflammation and higher long-term mortality than CCY.

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“…Ackerman in sodelavci so v svoji retrospektivni študiji ugotovili, da je celokupno več zapletov po operaciji in konverzij ter daljši čas hospitalizacije pri odloženi operaciji in po začetnem konzervativnem zdravljenju kot pri zgodnji operaciji (37). Yuval in Kamalapurkar na osnovi svojih štu-dij zaključujeta, da je zgodnja holecistektomija varna in učinkovita metoda zdravljenja tudi pri napredovalem vnetju (38,39). Mizrahi in sodelavci so pri bolnikih po odloženi holecistektomiji in predhodnem perkutanem dreniranju žolčnika opazovali večje število zapletov, kot so okužbe, konverzije, biliarne fistule, ponovni sprejem v bolnišnico in daljša hospitalizacija (40).…”

Section: Izsledki Kliničnih šTudij In Metaanalizunclassified

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

Janež¹

2018

SlovMedJour

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IzvlečekAkutno vnetje žolčnika oziroma akutni holecistitis je pogosta bolezen, ki večkrat zahteva sprejem v bolnišnico in kirurško zdravljenje. Najpogosteje se pojavlja pri ljudeh, ki imajo žolčne kamne, pojavi pa se lahko tudi v odsotnosti žolčnih kamnov. Diagnozo akutnega holecistitisa postavimo na osnovi klinične slike, laboratorijskih izvidov in ultrazvoka trebuha. Algoritmi za bolnike, ki imajo akutno vnetje žolčnika brez pridruženih bolezni, so znani; odločitev za kirurški poseg pri bolnikih s pridruženimi boleznimi pa je odvisna od več dejavnikov. Laparoskopska holecistektomija je metoda izbire zdravljenja bolnikov z akutnim holecistitisom. Rezultati zdravljenja so bistveno boljši, kadar kirurški poseg napravimo znotraj 72 ur od nastopa kliničnih znakov.V prispevku so predstavljena najnovejša priporočila za obravnavo bolnikov z akutnim holecistitisom, povzeta po smernicah iz Tokia ter smernicah Svetovnega združenja za urgentno kirurgijo iz leta 2016 ter na koncu še izsledki in izkušnje nekaterih kliničnih študij in metaanaliz. AbstractAcute cholecystitis is a common disease, which often requires admission to hospital and surgical treatment. Acute cholecystitis is defined as inflammation of the gallbladder and usually occurs due to cystic duct obstruction from stones or sludge. It is a relatively common complication of gallstones, but it can also occur without gallstones. A combination of relevant clinical symptoms and ultrasound evidence is required to make a diagnosis of acute cholecystitis. Early surgery is recommended for all patients that are in good physical condition. There is still a debate how to treat high-risk and critically ill patients. Laparoscopic cholecystectomy is the method of choice for treatment of patients with acute cholecystitis. Early laparoscopic cholecystectomy should be done within 72 hours from the onset of symptoms. This article presents current guidelines according to the Tokyo guidelines and the World Society of Emergency Surgery guidelines, and at the end, experiences of some clinical trials. UvodAkutno vnetje žolčnika oziroma akutni holecistitis je pogosto bolezen, ki velikokrat zahteva bolnišnično zdravljenje in operacijo. Najpogosteje se pojavlja pri ljudeh z žolčnimi kamni, lahko pa tudi brez njih (1). Vnetje žolčnika brez prisotnosti kamnov je pogostejše pri kritično bolnih, ki so dlje časa na parenteralni prehrani, pri politravmatiziranih bolnikih, pri večjih opeklinah in pri bolnikih po srčnih operacijah (2). Akutni holecistitis je še posebej pogost vzrok

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Index cholecystectomy in grade II and III acute calculous cholecystitis is feasible and safe

Abstract: Index cholecystectomy is feasible with low morbidity and no mortality even in severe ACC. Emergency cholecystectomy in the setting of severe cholecystitis appear to be safe and technically feasible option.

Cited by 34 publications

References 33 publications

Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Validation of TG13 severity grading in acute cholecystitis: Japan‐Taiwan collaborative study for acute cholecystitis

Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

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