Análisis del tratamiento quirúrgico más apropiado para la colecistitis aguda mediante aplicación del método RAND/UCLA

Abstract

IntroductionAcute cholecystitis (AC) is a common indication for cholecystectomy. Local circumstances and certain patient characteristics lead to high failure rates and complications in laparoscopic cholecystectomy (LC), and despite the experience gained, we still do not have a detailed list of indications which could minimise them. Material and methodWe used the RAND/UCLA Appropriateness Method (RAM) to evaluate 2 options, LC and open cholecystectomy (OC). An expert panel analysed its suitability after a literature review, a consensus meeting, and 2 rounds of scores on different clinical situations. The score of each scenario was analysed to establish the appropriateness level of each option. ResultsAt the end of the meeting there were 64 defined scenarios, with an agreement being reached on the indications in 67.18% of them. In 86.04% of the scenarios, the agreement was due to the appropriateness of the indications. When cholecystectomy was indicated, it was always by laparoscopy, while it was only occasionally by laparotomy. In patients with less than 72h of onset, LC was always considered appropriate when there was sepsis, or even without this if the ultrasound data showed complicated AC. ConclusionsThere is still uncertainty as regards the management of AC, especially as regards the timing of the operation and the surgical approach, particularly in frail patients and with a clinical onset greater than 72h. The RAND method can help to make decisions on the appropriateness of different therapeutic options.