Cholecystectomy For Acute Calculous Cholecystitis Research Articles

Textbook outcome in urgent early cholecystectomy for acute calculous cholecystitis: results post hoc of the S.P.Ri.M.A.C.C study

IntroductionA textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis.ObjetiveThe objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO.Materials and methodsThis is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC.Outcomes1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC.ConclusionKnowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.

Robotic Cholecystectomy Remains Safe and Effective After Regular Staffing Hours.

Background Robotic-assisted surgery continues to grow in popularity. Access during evenings and weekends for non-elective operations can be restricted out of safety concerns. We sought to analyze and compare outcomes of patients undergoing robotic cholecystectomy, a common urgent procedure for acute calculous cholecystitis, during regular hours versus evenings or weekends. Based on this comparison, we sought to determine if this restriction is justified. Methods We performed a retrospective analysis of 46 patients who underwent robotic cholecystectomy for acute calculous cholecystitis per 2018 Tokyo criteria by a single surgeon at a single institution between 2021 and 2022. Patients were grouped as undergoing "after-hours" cholecystectomy if the operation started at five pm or later, or anytime during the weekend (Saturday, Sunday). Demographic, perioperative, and outcome variables were tabulated and analyzed. For illustrative purposes, the data presented as median ± standard deviation were applicable. Results After-hours cholecystectomy occurred in 26 patients and regular-hours cholecystectomy occurred in 20 patients. There were no significant differences in perioperative variables between the two cohorts in terms of body mass index, age, gender, cirrhotic status, American Society of Anesthesiology score, white blood cell count, or neutrophil percentage. The after-hours group had more prior abdominal operations. There were no significant differences between the two groups in terms of operative time, estimated blood loss, or length of stay. There were no mortalities. There was one readmission in the after-hours cohort unrelated to the operation. Conclusion Robotic cholecystectomy can be safely performed on the weekends and evenings. Hospitals should make the robotic platform available during this time.

Timing of Early Cholecystectomy for Acute Calculous Cholecystitis: A Multicentric Prospective Observational Study.

The definition of Early Cholecystectomy (EC) is still debatable. This paper aims to find whether the timing of EC affects outcomes. The article reports a multicentric prospective observational study including patients with acute calculous cholecystitis (ACC) who had cholecystectomy within ten days from the onset of symptoms. Kruskall-Wallis test, Fisher's Exact test, and Spearman rank correlation were used for statistical analysis. The patients were divided into three groups depending on the timing of the operation: 0-3 days, 4-7 days, or 8-10 days from the onset of symptoms. 1117 patients were studied over a year. The time from the onset of symptoms to EC did not affect the post-operative complications and mortality, the conversion, and the reintervention rate. The time represented a significant risk factor for intraoperative complications (0-3 days, 2.8%; 4-7 days, 5.6%; 8-10 days, 7.9%; p = 0.01) and subtotal cholecystectomies (0-3 days, 2.7%; 4-7 days, 5.6%; 8-10 days, 10.9%; p < 0.001). ACC is an evolutive inflammatory process and, as the days go by, the local and systemic inflammation increases, making surgery more complex and difficult with a higher risk of intraoperative complications. We recommend performing EC for ACC as soon as possible, within the first ten days of the onset of symptoms.

Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis: A Secondary Center Experience.

Background Laparoscopic cholecystectomy (LC) has increasingly been accepted as the procedure of choice for the treatment of acute cholecystitis (AC). However, the timing of this procedure in the management of AC remains controversial. Hence this study was conducted to assess the feasibility of early laparoscopic cholecystectomy in acute cholecystitis. Materials and methods Patients who presented with symptoms of acute cholecystitis such as pain and tenderness in the right upper quadrant, systemic signs of inflammation, and positive ultrasound findings according to Tokyo guidelines were included for evaluation. Group 1 includes patients presented within 24 hours of the onset of symptoms whereas those presented between 25 and 72 hours of the onset of symptoms belonged to Group 2. All patients were taken up for early LC after assessment. Intraoperative and postoperative complications were analysed. Results Out of 120 patients, 37 belonged to Group 1 (30.83%) and 83 belonged to Group 2 (69.17%). There was a significant difference between the study groups in terms of certain demographic, laboratory findings and duration of surgery. None of the patients in Group 1 developed postoperative complications, whereas one patient in Group 2 had a bile leak on postoperative Day 2. Group 2 had a higher conversion rate to open procedure (p = 0.059). The mean duration of hospital stay for patients in Groups 1 and 2 were 3 and 3.3 days, respectively. Conclusion Laparoscopic cholecystectomy is safeand feasible with minimal conversion rates in patients presenting with early symptoms of AC. With the availability of good visualisation, optics, instruments and energy sources, good outcomes can be achieved.

Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study

BackgroundLess invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models.MethodThe S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models—POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade—receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities.ResultsA 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a ‘Chole-POSSUM’ score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96–97% negative predictive value for major complications.ConclusionsThe Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action.Trial Registration: ClinicalTrial.gov NCT04995380.

Evaluation of early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis: a prospective, randomized study.

Uncertainty exists about whether early laparoscopic cholecystectomy (LC) is an appropriate surgical treatment for acute calculous cholecystitis. This study aimed to compare early vs. late LC for acute calculous cholecystitis regarding intraoperative difficulty and postoperative outcomes. This was a prospective randomized study carried out between December 2015 and June 2017; 60 patients with acute calculous cholecystitis were divided into two groups (early and delayed groups), each comprising 30 patients. Thirty patients treated with LC within 3 to 5 days of arrival at the hospital were assigned to the early group. The other 30 patients were placed in the delayed group, first treated conservatively, and followed by LC 3 to 6 weeks later. The conversion rates in both groups were 6.7% and 0%, respectively (p = 0.143). The operating time was 56.67 ± 11.70 minutes in the early group and 75.67 ± 20.52 minutes in the delayed group (p = 0.001), and both groups observed equal levels of postoperative complications. Early LC patients, on the other hand, required much fewer postoperative hospital stay (3.40 ± 1.99 vs. 6.27 ± 2.90 days, p = 0.006). Considering shorter operative time and hospital stay without significant increase of open conversion rates, early LC might have benefits over late LC.

Is Antibiotic Therapy Necessary after Emergency Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis?

Background: While preoperative antibiotic therapy is standard to prevent surgical site infections in acute calculous cholecystitis, prescribing antibiotics after discharge is controversial. This study aimed to investigate the effect of antibiotic administration in discharge prescription on surgical site infections.&#x0D; Methods: Data from patients who underwent emergency laparoscopic cholecystectomy for acute calculous cholecystitis between January 2018 and February 2020 were retrospectively reviewed. Those with a decompensated systemic disease, those who were converted to open cholecystectomy, those with stage 3 disease, and those who underwent open cholecystectomy and cholecystostomy were excluded. Ampicillin-sulbactam 1 g was administered parenterally three times a day before and after surgery.&#x0D; The patients were divided into two groups according to their discharge prescriptions: those who were given antibiotics (AB group) and those who were not given antibiotics (NA group). The primary outcome was the development of surgical site infections.&#x0D; Results: 107 patients in the AB group and 109 in the NA group. Surgical site infection developed in 29 (13.4%) patients, 11 (10.3%) in the AB group, and 18 (16.5%) in the NA group. No significant difference was found between the two groups regarding surgical site infection rate (p&gt;0.05). In logistic regression analysis, obesity was a risk factor for surgical site infections.&#x0D; Conclusions: Failure to prescribe ampicillin-sulbactam to acute calculous cholecystitis patients discharged after laparoscopic surgery does not increase surgical site infections. However, prescribing ampicillin-sulbactam to obese patients may reduce surgical site infections.&#x0D; Keywords: Surgical site infections, acute calculous cholecystitis, emergency laparoscopic cholecystectomy, obesity

Outcome of Laparoscopic Cholecystectomy in Acute Calculous Choleycystitis – Analysis of 100 cases

Introduction: Gallbladder disease is one of the most common surgical problems worldwide. About 10-15% of the adult western population has gallstone diseases . More than half a million cholecystectomies are performed per year in United States alone. Laparoscopic cholecystectomy (LC) is currently the most widely used surgical procedure for the treatment of gallstones. Aims and Objectives: To observe the cause of difficulties, the sequele , identify and find out the nature &amp; rate of per operative complications and find out the type &amp; frequency of early post-operative complications following laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and Methods: This is a prospective interventional study which was conducted at Jashore Medical College Hospital &amp; some clinics of the city from Sept 2019 to Feb 2020. A total of 100 patients underwent Laparoscopic cholecystectomy for acute calculous cholecystitis within 7 days of admission. Results:Among 100 patients, 80 females &amp; 20 males with maximum age group were in the fourth decade, Laparoscopic cholecystectomy was done in 97 (97%) cases &amp; in 3(3%) cases conversion were needed, none of the patients were developed major Per &amp; postoperative complications. Peroperative complication rate was 22 (22%) with conversion was 03(3%) cases. All of the above complications were managed accordingly &amp; successfully. Conclusion: Laparoscopic Cholecystectomy is a safe, effective procedure for the early management of patients with acute calculus cholecystitis. Meticulous dissection &amp; good exposure of callot’s triangle, posterior clearance may prevent bile duct injuries. Medicine Today 2022 Vol.34(1): 39-43

Feasibility and Effectiveness of an Enhanced Recovery Program after Early Cholecystectomy for Acute Calculous Cholecystitis: A 2-Step Study.

Enhanced recovery programs (ERPs) are associated with a lower morbidity rate and a shorter length of stay. The present study's objective was to determine whether an ERP is feasible and effective for patients undergoing early cholecystectomy for grade I or II acute calculous cholecystitis. A 2-step multicenter study was performed. In the first step (the feasibility study), patients were consecutively included in a dedicated, prospective database from March 2019 until January 2020. The primary endpoint was the ERP's feasibility, evaluated in terms of the number and nature of the ERP components applied. During the second step, the ERP's effectiveness in acute calculous cholecystitis was evaluated in a case-control study. The ERP+ group comprised consecutive patients who were prospectively included from March 2019 to November 2020 and compared with a control (ERP-) group of patients extracted from the ABCAL randomized controlled trial treated between May 2010 and August 2012 and who had not participated in a dedicated ERP. During the feasibility study, 101 consecutive patients entered the ERP with 17 of the 20 ERP components applied. During the effectiveness study, 209 patients (ERP+ group) were compared with 414 patients (ERP- group). The median length of stay was significantly shorter in the ERP+ group (3.1 vs 5 days; p < 0.001). There were no intergroup differences in the severe morbidity rate, mortality rate, readmission rate, and reoperation rate. Implementation of an ERP after early cholecystectomy for acute calculous cholecystitis appeared to be feasible, effective, and safe for patients. The ERP significantly decreased the length of stay and did not increase the morbidity rate.

Laparoscopic Cholecystectomy in Acute Calculous Cholecystitis (Study of 75 cases)

Background: Acute calculous cholecystitis is one of the commonest biliary tract emergencies. The advent of laparoscopic cholecystectomy has brought about a change in the treatment approach from conservative to emergency surgical intervention. Emergency laparoscopic cholecystectomy is emerging as the standard of care. Therefore the need to evaluate the various factors which determine the safety of the procedure. Aims: The aim of the study is to evaluate the efficacy and safety of laparoscopic cholecystectomy in acute calculous cholecystitis. Materials and methods: Consecutive patients who underwent laparoscopic cholecystectomy for acute calculous cholecystitis over a 2-year-old period were studied prospectively. Results: 75 patients were evaluated. The mean age was 49.48 years. Majority presented with right hypochondriac pain. 22 patients had hypertension. 26 had diabetes and 6 patients had both hypertension and diabetes. In 61 patients the mean duration of surgery was less than 60 minutes. 5 patients needed conversion to an open procedure. 10 patients developed complications. The mean hospital stay was 4.34 days. Conclusion: Early emergency laparoscopic cholecystectomy is a safe and viable option for treating acute calculous cholecystitis.

COMPARISON OF OUTCOMES BETWEEN EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS

Objective: To compare early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of mean operative time, hospital stay, conversion rate to open surgery and post-operative complications.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Army Liver Transplant Unit, Department of Surgery, Pak-Emirates Military Hospital Rawalpindi, from Jul to Dec 2018.&#x0D; Methodology: A total of 170 patients (85 in each group) diagnosed as a case of acute calculous cholecystitis who met the sample selection criteria were included. Group A patients underwent early laparoscopic cholecystectomy within 72 hours of admission while group B patients underwent conservative management followed by delayed laparoscopic cholecystectomy after 6 weeks. All patients were followed for operative time, hospital stay, per-operative difficulties encountered and post-operative complications.&#x0D; Results: Group A had a mean operation time of 43.9 ± 11.1 minutes, while group B had a mean operation time of 45.8 ± 10.1 minutes (p=0.83). The mean duration of hospitalization was 2.8 ± 1.1 days in group A and 5.3 ± 0.8 days in group B (p&lt;0.001). Complications were measured at a frequency of 14.1% in group A and 5.9% in group B (p=0.07).&#x0D; Conclusion: Early laparoscopic cholecystectomy is better than delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of hospital stay and per-operative difficulties faced. The post-operative complications between the two groups are comparable.

A rare case report: left-sided gall bladder without situs inversus viscerum

Left-sided gall bladder without situs inversus viscerum is a rare clinical entity. A left-sided gall bladder is a rare congenital anomaly defined as a gall bladder attached to the lower surface of the left lateral segment of the liver, to the left of the inter-lobar fissure and round ligament. We reported our experience of one cases of left-sided gall bladder in a woman aged 45 years who underwent laparoscopic cholecystectomy for acute calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD) and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity. One previous case reported had shown cystic duct opened into the common hepatic duct on its right side in a patient with left sided gall bladder.

Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis: a meta-analysis of randomized clinical trials

BackgroundEarly cholecystectomy for acute cholecystitis has proved to reduce hospital length of stay but with no benefit in morbidity when compared to delayed surgery. However, in the literature, early timing refers to cholecystectomy performed up to 96 h of admission or up to 1 week of the onset of symptoms. Considering the natural history of acute cholecystitis, the analysis based on such a range of early timings may have missed a potential advantage that could be hypothesized with an early timing of cholecystectomy limited to the initial phase of the disease. The review aimed to explore the hypothesis that adopting immediate cholecystectomy performed within 24 h of admission as early timing could reduce post-operative complications when compared to delayed cholecystectomy.MethodsThe literature search was conducted based on the Patient Intervention Comparison Outcome Study (PICOS) strategy. Randomized trials comparing post-operative complication rate after early and delayed cholecystectomy for acute cholecystitis were included. Studies were grouped based on the timing of cholecystectomy. The hypothesis that immediate cholecystectomy performed within 24 h of admission could reduce post-operative complications was explored by comparing early timing of cholecystectomy performed within and 24 h of admission and early timing of cholecystectomy performed over 24 h of admission both to delayed timing of cholecystectomy within a sub-group analysis. The literature finding allowed the performance of a second analysis in which early timing of cholecystectomy did not refer to admission but to the onset of symptoms.ResultsImmediate cholecystectomy performed within 24 h of admission did not prove to reduce post-operative complications with relative risk (RR) of 1.89 and its 95% confidence interval (CI) [0.76; 4.71]. When the timing was based on the onset of symptoms, cholecystectomy performed within 72 h of symptoms was found to significantly reduce post-operative complications compared to delayed cholecystectomy with RR = 0.60 [95% CI 0.39;0.92].ConclusionThe present study failed to confirm the hypothesis that immediate cholecystectomy performed within 24 h of admission may reduce post- operative complications unless surgery could be performed within 72 h of the onset of symptoms.

Predictive factors of conversion in laparoscopic cholecystectomy for acute calculous cholecystitis

Purpose: Identify the predictive factors for conversion and to evaluate conversion’s impact on postoperative morbidity and mortality. Method: A retrospective study in the surgical department at Mongi Slim Hospital. We enrolled 300 patients who underwent LC for ACC between January 2015 and December 2018. Patients were divided into two groups: “Laparoscopy” for the 282 successful Laparoscopic cholecystectomies (LC) and “Conversion” for the 18 Convertions to open (CTO). A descriptive analysis of preoperative, intraoperative and postoperative data was performed, followed by a bivariate and a multivariate analysis comparing the two groups. The significance level was set at 0.05. Results: The conversion rate was 6%. The sex-ratio was 0.47. The median age was 50 years with interquartile range of 38-62 years. Bivariate analysis identified the following factors: male gender (p=0.001), age over 57 years (p=0.002), right upper quadrant tenderness (p=0.009), right upper quadrant guarding (p=0.006), leukocytosis ≥ 18000 cells /mL (p=0.002), leukopenia (<0.001), serum creatinine level > 20 mg/L (p=0.045), ultrasonographic findings like laminated gallbladder wall (p=0.033), pericholecystic abscess (p=0.045), liver abscess (p<0.001), intra-abdominal effusion (p=0.001), ACC grade II (p=0.009) and intraoperative findings like pericholecystic adhesions (p<0.001), gangrenous ACC (p=0.001), pericholecystic abscess (p=0.005), localized peritonitis (p=0.028), pediculitis (p=0.006), difficulties in identifying anatomical structures (p=0.014) and bile duct injuries (p<0.001). Multivariate analysis determined as predictive factors: male gender (OR=3.715; 95% CI [1.101-12.541]; p=0.03) and age over 57 years (OR=1.038; 95% CI [1-1.077]; p=0.04). There were no differences between the two groups in terms of postoperative morbidity and mortality. However, CTO was associated with a prolonged length of stay (p=0.02). Conclusion: The predictive factors of CTO are not modifiable. Their identification may help conduct a better communication with the patient and optimize the planning of the procedure.

Feasibility and efficacy of an enhanced recovery program after early cholecystectomy for acute calculous cholecystitis, a two step study

Feasibility and efficacy of an enhanced recovery program after early cholecystectomy for acute calculous cholecystitis, a two step study

Spontaneous Pneumoperitoneum due to Intra-abdominal Drain- A Case Report

Pneumoperitoneum is most commonly caused by hollow viscus perforation which requires an emergency surgical intervention. However, this is not always the case. Pneumoperitoneum which is not due to hollow viscus perforation is called Spontaneous or “non-surgical” pneumoperitoneum. Rarely, it can present with peritonitis but non-surgical pneumoperitoneum usually follows a benign course and can be managed conservatively. A case of 53-year-old male, non-smoker, non-alcoholic, hypertensive known to have decompensated chronic liver disease, since one year with portal hypertension and ascites was presented. The patient underwent uneventful laparoscopic cholecystectomy for acute calculous cholecystitis and developed spontaneous pneumoperitoneum due to intra-abdominal drain one week postprocedure. Pneumoperitoneum was successfully managed conservatively. A thorough history, physical examination and imaging are crucial in identifying patients with non-surgical pneumoperitoneum and to prevent unnecessary laparotomies. In present case, pneumoperitoneum was due to intra-abdominal drain which resolved after removing the drain. So, it is of utmost importance to rule out non-surgical causes of pnemoperitoneum, especially in surgeries where drain are kept in-situ.

Timing of early laparoscopic cholecystectomy for acute calculous cholecystitis revised: Protocol of a systematic review and meta-analysis of results

BackgroundEarly laparoscopic cholecystectomy has been adopted as the treatment of choice for acute cholecystitis due to a shorter hospital length of stay and no increased morbidity when compared to delayed cholecystectomy. However, randomised studies and meta-analysis report a wide array of timings of early cholecystectomy, most of them set at 72 h following admission. Setting early cholecystectomy at 72 h or even later may influence analysis due to a shift towards a more balanced comparison. At this time, the rate of resolving acute cholecystitis and the rate of ongoing acute process because of failed conservative treatment could be not so different when compared to those operated with a delayed timing of 6–12 weeks. As a result, randomised comparison with such timing for early cholecystectomy and meta-analysis including such studies may have missed a possible advantage of an early cholecystectomy performed within 24 h of the admission, when conservative treatment failure has less potential effects on morbidity. This review will explore pooled data focused on randomised studies with a set timing of early cholecystectomy as a maximum of 24 h following admission, with the aim of verifying the hypothesis that cholecystectomy within 24 h may report a lower post-operative complication rate compared to a delayed intervention.MethodsA systematic review of the literature will identify randomised clinical studies that compared early and delayed cholecystectomy. Pooled data from studies that settled the early intervention within 24 h from admission will be explored and compared in a sub-group analysis with pooled data of studies that settled early intervention as more than 24 h.DiscussionThis paper will not provide evidence strong enough to change the clinical practice, but in case the hypothesis is verified, it will invite to re-consider the timing of early cholecystectomy and might promote future clinical research focusing on an accurate definition of timing for early cholecystectomy for acute cholecystitis.

Impact of the implementation of partial enhanced recovery program after cholecystectomy for acute calculous cholecystitis

Impact of the implementation of partial enhanced recovery program after cholecystectomy for acute calculous cholecystitis

Absence of antibiotherapy after cholecystectomy for acute calculous cholecystitis: Do we apply the recommendations? Applicability of the ABCAL Study

Absence of antibiotherapy after cholecystectomy for acute calculous cholecystitis: Do we apply the recommendations? Applicability of the ABCAL Study

Drain in laparoscopic cholecystectomy in acute calculous cholecystitis: a randomised controlled study

BackgroundThere is paucity of evidence regarding the role of drain in laparoscopic cholecystectomy (LC) in acute calculous cholecystitis (ACC), and surgeons have placed the drains based on their experiences, not...