Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome

Giger, Urs; Michel, Jean-Marie; Vonlanthen, René; Becker, Klaus; Kocher, Thomas; Krähenbühl, L.

doi:10.1007/s00423-004-0509-4

Cited by 44 publications

(33 citation statements)

References 55 publications

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“…The switch was also made in patients where gallbladder cancer was found during surgery, as well as in some other patient subpopulations (Fig. 2) [29][30][31][32][33][34]. Multivariate analysis has identified the presence of acute cholecystitis and a finding of thickening of the gallbladder wall as significant independent factors for switching to open surgery [35,36].…”

Section: Commentarymentioning

confidence: 99%

“…1) [25][26][27][28]. It has been reported that 3.6-8% of laparoscopic cholecystectomies are intraoperatively switched to open procedures for a variety of reasons, including technical difficulties, biliary tract damage, anesthesia problems, and device malfunction [29][30][31][32]. The switch to open cholecystectomy occurred more frequently in men than in women; in patients aged 60 years or older; and in those with a history of upper abdominal surgery, diabetes, existing cardiovascular disease, marked inflammation (i.e., acute cholecystitis), a stone impacted in the cervix of the gallbladder, pericholecystic abscess, thickened gallbladder wall, elevated alkaline phosphatase level, or a high white blood cell count.…”

Section: Commentarymentioning

confidence: 99%

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Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

198

177

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Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

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Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

198

177

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“…Elshaer et al suggested that the most common indicator of subtotal cholecystectomy is severe cholecystitis and that the attempt to expose the cystic duct or artery is potentially dangerous in patients who have fibrosis in the Calot's triangle area [24]. Similarly, Giger et al recommended open conversion in patients with extensive inflammation [25]. These reports alert surgeons to be extremely cautious whenever they cannot recognize surgical anatomy; nevertheless, none of these studies articulate whether the critical view of safety proposed by Strasberg et al can be obtained in such situations [26,27].…”

Section: Discussionmentioning

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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“…Increased risk of conversion in acute cholecystitis is not a contraindication for minimally invasive therapy. On the contrary, performing laparoscopic cholecystectomy, especially during the initial stage of the disease, is a procedure that is safe and benefi cial for the patient, despite greater technical diffi culties (14,15,16).…”

Section: Discussionmentioning

confidence: 99%

Analysis of Conversion Rates and Reasons in Minimally Invasive Surgery

Strzałka¹,

Budzyński²,

Bobrzyński³

et al. 2009

Polish Journal of Surgery

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Nowadays the number and range of laparoscopic procedures is quickly increasing and contraindications are limited. But laparoscopic operations cannot be performed in every case, what leads to conversion. The aim of the study was to present the conversion rates and reasons in different types of laparoscopic procedures, both emergency and elective. Material and methods. 7685 patients operated laparoscopically in the 2 nd Department of General Surgery of the Jagiellonian University between 1993 and 2008 were included in the study. Minimally invasive approach was used at the beginning in 608 patients with acute appendicitis (average age = 28,4 years), in 101 patients with perforated peptic ulcer (average age = 46.4 years), in 236 patients who underwent splenectomy (average age = 41 years), in 166 patients who had adrenalectomy (average age = 53 years), in 117 patients who underwent Nissen fundoplication (average age = 44,4 years), in 834 individuals who had inguinal hernia repair (average age = 49.4years), in 5311 who had cholecystectomy (average age = 52.1 years and in 212 patients who underwent other procedures. Results. The conversion rates in the analyzed period were 2.88% in whole material, in case of appendectomy 3,95%, perforated ulcer operation 19,80%, splenectomy 2.12%, adrenalectomy 1.81%, Nissen fundoplication 1.71%, inguinal hernia repair 0.96% and cholecystectomy 2.92%. Emergency surgery was related to higher (4.98%) conversion rate than elective procedures (1.88%). Most frequently convestions were related to technical reasons (2,48%), than enforced by complications (0.41%). Conclusion. Most conversions were caused by technical reasons, not complications. The change of the approach from laparoscopic to open one was more frequent in case of emergency procedures.

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Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome

Cited by 44 publications

References 55 publications

Evidence-based clinical practice guidelines for cholelithiasis 2016

Evidence-based clinical practice guidelines for cholelithiasis 2016

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

Analysis of Conversion Rates and Reasons in Minimally Invasive Surgery

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