Outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis performed at a single institution

Kohga, Atsushi; Suzuki, Kenji; Okumura, Toshikatsu; Yamashita, Kimihiro; Isogaki, Jun; Kawabe, Akihiro; Kimura, Taizo

doi:10.1111/ases.12487

Cited by 15 publications

(15 citation statements)

References 32 publications

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“…First, PC placement makes laparoscopic surgery difficult. Previous studies have reported a significantly high rate of conversion to open surgery among patients who had undergone PC placement before surgery and showed that PC placement is an independent risk factor for this type of conversion 18,19 . In our study, two patients in the delayed group underwent PC placement, and one required conversion.…”

Section: Discussionmentioning

confidence: 44%

“…Previous studies have reported a significantly high rate of conversion to open surgery among patients who had undergone PC placement before surgery and showed that PC placement is an independent risk factor for this type of conversion. 18,19 In our study, two patients in the delayed group underwent PC placement, and one required conversion. We suppose that PC placement causes bile leakage or a foreign body reaction and aggravates pericystic scarring, making it difficult to complete laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 76%

“…In our study, two patients in the delayed group underwent PC placement, and one required conversion. We suppose that PC placement causes bile leakage or a foreign body reaction and aggravates pericystic scarring, making it difficult to complete laparoscopic surgery 19 . Second, during the waiting period before delayed surgery, more than a few patients have had recurrent symptoms or dislodgement of the drainage tube, both of which require reintervention 16,20 .…”

Section: Discussionmentioning

confidence: 99%

“…We suppose that PC placement causes bile leakage or a foreign body reaction and aggravates pericystic scarring, making it difficult to complete laparoscopic surgery. 19 Second, during the waiting period before delayed surgery, more than a few patients have had recurrent symptoms or dislodgement of the drainage tube, both of which require reintervention. 16,20 An operation might be more difficult if a patient has developed recurrent symptoms due to an additional change in the pericystic inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

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Does early surgery imply a critical risk for patients with Grade III acute cholecystitis?

Kohga¹,

Okumura²,

Yamashita³

et al. 2020

Asian J Endoscop Surgery

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Background: For patients with Grade III acute cholecystitis (AC), several factors have been proposed in the 2018 Tokyo guidelines as caution signs in performing early surgery. However, these factors have not been externally validated in detail. Methods: This retrospective study examined 35 patients who had been diagnosed with Grade III AC and treated with laparoscopic cholecystectomy between January 2008 and July 2019. The patients were allocated into an early group (patients who underwent surgery within 7 days of admission, n = 28) and a delayed group (patients who underwent surgery at least 8 days after admission, n = 7). Comparisons were made between these groups. Results: No patients died. Significantly more patients required a conversion to open surgery (0% vs 28.5%, P = .003) or conversion to subtotal cholecystectomy (25.0% vs 71.4%, P = .020) in the delayed group than in the early group, and the total length of postoperative stay was significantly longer in the delayed group (11.4 vs 27.2 days, P = .001). The presence of negative predictive factors or risk factors listed in the 2018 Tokyo guidelines was not associated with death or postoperative complications. Conclusions: Early surgery was considered appropriate and feasible for select patients who had Grade III AC and preoperative risk factors.

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Does early surgery imply a critical risk for patients with Grade III acute cholecystitis?

Kohga¹,

Okumura²,

Yamashita³

et al. 2020

Asian J Endoscop Surgery

Self Cite

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“…Laparoscopic cholecystectomy undertaken during the index admission is the standard of care for patients with acute cholecystitis and also for those with mild or moderate acute biliary pancreatitis (1)(2)(3). Index-admission management of symptomatic gallstone disease prevents recurrent biliary events and reduces healthcare costs (4,5). For such a strategy to be feasible, the necessary surgical expertise must be available to provide this level of care.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background: Index admission laparoscopic cholecystectomy is the standard of care for patients admitted to hospital with symptomatic acute cholecystitis. The same standard applies to patients suffering with mild acute biliary pancreatitis. Operating theatre capacity can be a significant constraint to same admission surgery. This study assesses the impact of dedicated theatre capacity provided by a specialist surgical team on rates of index admission cholecystectomy.Methods: This clinical cohort study compares the management of patients with symptomatic gallstone disease admitted to a tertiary care university teaching hospital over two equal but chronologically separate time periods. The periods were before and after service reconfiguration including a specialist HPB service with dedicated operating theatre time allocation.Results: There was a significant difference in the number of admissions over the two time periods with a greater proportion of patients having index admission surgery in the second time period with correspondingly fewer having more than one admission during this latter time period. In the second time period 43% of patients underwent index admission cholecystectomy compared to 23% in the first (P < 0.001). The duration of surgery was shorter for patients undergoing surgery during the second time period [135 (102–178) min in the first period and in the second period 106 (89–145) min] (P = 0.02).Discussion: This paper shows that the concentration of theatre resources and surgical expertise into regular theatre access for patients undergoing urgent laparoscopic cholecystectomy is an effective and safe model for dealing with acute biliary disease.

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Risk factors for postoperative bile leak in patients who underwent subtotal cholecystectomy

Kohga¹,

Suzuki²,

Okumura³

et al. 2019

Surg Endosc

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Outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis performed at a single institution

Abstract: ELC for AC yields more favorable clinical outcomes than DLC.

Cited by 15 publications

References 32 publications

Does early surgery imply a critical risk for patients with Grade III acute cholecystitis?

Does early surgery imply a critical risk for patients with Grade III acute cholecystitis?

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

Risk factors for postoperative bile leak in patients who underwent subtotal cholecystectomy

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