Laparoscopic cholecystectomy in the Acute Care Surgery model: risk factors for complications

Abstract

BackgroundThe Acute Care Surgery (ACS) model developed during the last decade fuses critical care, trauma, and emergency general surgery. ACS teams commonly perform laparoscopic cholecystectomy (LC) for acute biliary disease. This study reviewed LCs performed by an ACS service focusing on risk factors for complications in the emergent setting.MethodsAll patients who underwent LC on an ACS service during a 26-month period were identified. Demographic, perioperative, and complication data were collected and analyzed with Fisher’s exact test, χ2 test, and Mann-Whitney U Test.ResultsDuring the study period, 547 patients (70.2% female, mean age 46.1±18.1, mean body mass index 32.4±7.8 kg/m2) had LC performed for various acute indications. Mean surgery time was 77.9±50.2 minutes, and 5.7% of cases were performed “after hours.” Rate of conversion to open procedure was 6%. Complications seen included minor bile leaks (3.8%), infection (3.8%), retained gallstones (1.1%), organ injury (1.1%), major duct injury (0.9%), and postoperative bleeding (0.9%). Statistical analysis demonstrated significant relationships between conversion, length of surgery, age, gender, and intraoperative cholangiogram with various complications. No significant relationships were detected between complications and BMI, pregnancy, attending experience, and time of operation.DiscussionAlthough several statistically significant relationships were identified between several risk factors and complications, these findings have limited clinical significance. Factors including attending years in practice and time of the operation were not associated with increased complications. ACS services are capable of performing a high volume of LCs for emergent indications with low complication and conversion rates.­Level of evidence:IV

The Analysis of Risk Factors in the Conversion from Laparoscopic to Open Cholecystectomy

“…In situations where LC is dangerous, a surgeon may be forced to change from laparoscopy to the open procedure. Literature data shows that 2 to 15% of laparoscopic cholecystectomies are converted to open surgery during surgery for various reasons [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The most common causes are peritoneal adhesions and inflammatory infiltration of the gallbladder [ 11 , 12 , 13 , 15 , 16 ].…”

“…Literature data shows that 2 to 15% of laparoscopic cholecystectomies are converted to open surgery during surgery for various reasons [ 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. The most common causes are peritoneal adhesions and inflammatory infiltration of the gallbladder [ 11 , 12 , 13 , 15 , 16 ]. Converted cases are associated with an increased number of infectious and other postoperative complications [ 8 , 17 , 18 , 19 , 20 ], an increased risk of additional procedures, and a higher rate of readmission within 30 days [ 21 ].…”

The Impact of a Dedicated “Hot List” on the In-Patient Management of Patients With Acute Gallstone-Related Disease

“…It is important to bear in mind that the study was undertaken in the United Kingdom's National Health Service. In the US the acute care surgery model has demonstrated the feasibility of this type of service to deliver high volume emergency cholecystectomies ( 11 ). Thus a “hot list” is only necessary if access to operating theatre time for acute biliary surgery is limited.…”

Prevalence of conversion of laparoscopic cholecystectomies in the Hospital de Clinicas during the year 2021

“…De todas maneras, existe un subgrupo de pacientes en los que se requiere una conversión a técnica abierta. Los datos de la literatura muestran que del 2 al 15% de las colecistectomías laparoscópicas se convierten a cirugía abierta por diversas razones (3)(4)(5) , Doi: 10.18004/sopaci.2021.diciembre. 19 siendo las causas más frecuentes las adherencias peritoneales y el proceso inflamatorio importante relacionado a la vesícula biliar (3,4,6) .…”