Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis

Kiviluoto, Tuula; Sirén, Jukka; Luukkonen, Pekka; Kivilaakso, Eero

doi:10.1016/s0140-6736(97)08447-x

Cited by 392 publications

(278 citation statements)

References 20 publications

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“…There are several studies that demonstrate the beneficial effects of laparoscopic techniques and the advantages of LC (Bickel et al 1996;Eldar et al 1997;Kiviluoto et al 1998;Lujan et al 1998). Researchers have shown that one of the most important benefits of LC is a decrease in hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Effects of Open vs. Laparoscopic Cholecystectomy on Oxidative Stress

Bukan

Kaymakçıoğlu

et al. 2004

Tohoku J. Exp. Med.

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Elective laparoscopic cholecystectomy is established as the treatment of choice for symptomatic cholecystolithiasis and is now proposed for the treatment of acute cholecystitis. The aim of this study is to evaluate biochemical aspects of open (OC) and laparoscopic cholecystectomy (LC). We measured the levels of malondialdehyde (MDA) and the levels of nitrite+nitrate as stable end products of nitric oxide (NO). MDA and nitrite+nitrate levels were increased at both surgical procedures compared to preoperative period, but the rise was more significant in OC than LC. These results showed that both OC and LC caused an increase in oxidative stress. However LC caused significantly less oxidative stress and the changes during surgery returned to preoperative values after LC in a shorter period. The beneficial effects of laparoscopic surgery may be related, partially, to less oxidative stress in the immediate postoperative period. laparoscopic cholecystectomy; open cholecystectomy; oxidative stress

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Section: Discussionmentioning

confidence: 99%

Effects of Open vs. Laparoscopic Cholecystectomy on Oxidative Stress

Bukan

Kaymakçıoğlu

et al. 2004

Tohoku J. Exp. Med.

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“…In addition, delayed surgery causes higher mortality and bile leak in our series. For these reasons, late surgery should be reserved only for high surgical risk patients having a poor clinical response to medical treatment and should always performed by surgeons with experience with this type of intervention [44][45]. More carefully selecting the type of treatment given immediately after the time of admission should reduce this number.…”

Section: Discussionmentioning

confidence: 99%

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed

González-Muñoz

Angoso

Sayagués

et al. 2014

Langenbecks Arch Surg

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Disclosure:The authors declare no conflict of interest. Number of text pages: 17Tables: 1 Figures: 2 Word count: 2222 AbstractPurpose Therapeutic recommendations of acute cholecystitis are not consistently implemented, which generates greater patient morbidity and higher health care costs.The aim of this article is to evaluate the burden of acute cholecystitis, to detect potentially modifiable variables and to propose a therapeutic strategy that will allow us to improve the quality of care.Methods We carried out a retrospective study of patients who were admitted to the hospital from January 2010 to December 2012 using a univariate analysis of parameters including the admitting department, age, treatment administered and length of stay.Results A total of 967 patients were admitted to the hospital with a diagnosis of acute cholecystitis, 692 (72%) to the Surgery department, 257 (26%) to Internal MedicineDigestive and 18 (2%) to other departments. 498 (51.5%) were operated on: 107 (21%) on an urgent basis, 111 (22%) at an early stage (<96 hours at diagnosis), 152 (30%) at a late stage (>96 hours at diagnosis) and 128 (26%) at a delayed date (other admission).Patients who were admitted into the surgery department were five times more likely to be operated on than patients admitted into other departments (p<0.01). Patients operated on at a late stage had a longer length of stay than early stage surgery patients (p<0.05) and than non operated ones (p<0.05). Patients <74 years old were more frequently operated than older ones (p<0.05). ConclusionsThe non-standardized treatment of acute cholecystitis causes high clinical and surgical variability, long average stay, more re-admissions and high hospital costs.Therefore, patients with a diagnosis of acute cholecystitis should be admitted to the Surgery department, thereby increasing the probability of receiving definite treatment.

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“…Low quality: it very likely that future studies change our confidence in the estimate of effect, therefore our confidence is low. Table. 2001; Elder, 1996;Finan, 2006;Zacks, 2002;Collet, 1997;Ibrahim, 2006;Weber, 2003;Feldman, 1994;Perez Lara, 2006;Sungler, 2000;Daradkeh, 1999;Ji, 2005;Fernandes, 2000;Palanivelu, 2006;da Silveira, 2006;Gurusamy, 2006;Chandler, 2000;Kiviluoto, 1998;Glavic, 2001;Eldar, 1998;Lujan, 1995;Tan, 2006;Perez-Morales, 2005;Bagia, 2001;Schafer, 2003;Kwon, 2001;Woods, 1996).…”

Section: Discussionmentioning

confidence: 99%

“…Elective surgery did not show any advantages in terms of operating time, complication rate, blood loss, and conversion rate or hospital stay as compared with urgent LC (Sungler, 2000). Another low quality RCT comparing safety and results of LC vs. open surgery in patients with gangrenous AC found a similar operating duration and hospital stay but time to return to work was longer in the open group (Kiviluoto, 1998), (Treatment studies 2b). A retrospective cohort examining patients with AC who underwent open and laparoscopic procedures noted that LC was superior, with lower analgesic use, shorter hospital stay and less temporal disability (Glavic, 2001).…”

Section: (Treatment Studies 2b)mentioning

confidence: 96%

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

et al. 2010

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SUMMARY:The aim of the present study was to evaluate the available evidence on the effectiveness of laparoscopic surgery for treating gallstones and common bile duct lithiasis (CBDL). A systematic overview was performed. Medline, EMBASE and The Cochrane Library were searched (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Systematic reviews (SR), clinical practice guidelines (CPG), randomised clinical trials (RCT) and observational studies were included. Internal validity and overall quality of the evidence were assessed. The available evidence was classified according to the Oxford Centre for Evidence Based Medicine proposal. 87 studies were included in this review (12 SR, 23 RCT, 3 CPG, 13 cohort studies, 3 cross-sectional studies, 2 case and control studies and 31 case series). Compared with open cholecystectomy, laparoscopic cholecystectomy (LC) is associated with shorter operating time, shorter hospital stay and better quality of life (high quality evidence). The use of antibiotic prophylaxis does not appear to reduce the infection rate in low-risk patients (high quality evidence). Although many techniques have been advocated to perform LC their effectiveness is as yet inconclusive (low-quality evidence). Two-stage surgery is the most appropriate strategy for high-risk patients with CBDL (high-quality evidence). Mortality is similar to open surgery, as the effectiveness is similar to that of endoscopic treatment (high-quality evidence). As a conclusion we can state that the evidence concerning the effectiveness of laparoscopic surgery for gallstones and CBDL is scarce and of low methodological quality and that better quality studies are warranted to assess these techniques more adequately.

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Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis

Cited by 392 publications

References 20 publications

Effects of Open vs. Laparoscopic Cholecystectomy on Oxidative Stress

Effects of Open vs. Laparoscopic Cholecystectomy on Oxidative Stress

Improving the outcome of acute cholecystitis: the non-standardized treatment must no longer be employed

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

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