Cholecystectomy For Acute Cholecystitis Research Articles

Acute Cholecystitis and the Controversies of Treatment

Key Learning Points:
 1. Acute cholecystitis is often a complication of gallstones disease
 2. Most of patients with symptomatic gallstones disease are prone to further complications and cholecystectomy is indicated
 3. Laparoscopic early cholecystectomy in acute cholecystitis is superior to delayed cholecystectomy in terms of symptom control, hospital stay and re-admissions, with similar morbidity and mortality and should be attempted in all cases of acute cholecystitis. Difficult cases should be managed by experienced surgeons, in advanced centers, and bail-out procedures should be attempted as per Tokyo guidelines.
 4. Percutaneous cholecystostomy should only be used in patients unfit for surgery who fail to improve
 5. The data available to support optimal antibiotical treatment is scarce, and local microbiology guidelines should be used.

EUS-guided Gallbladder Drainage Instead of Laparoscopic Cholecystectomy for Acute Cholecystitis. A Feasibility Study.

EUS-guided Gallbladder Drainage Instead of Laparoscopic Cholecystectomy for Acute Cholecystitis. A Feasibility Study.

Optimal timing and influencing factors of laparoscopic cholecystectomy for acute cholecystitis

Objective To explore the best operative time of laparoscopic cholecystectomy for acute cholecystitis, and analyze the causes of laparotomy. Methods The clinical data of 82 cases of laparoscopic cholecystectomy in the Department of General Surgery, the Eighth People's Hospital of Taiyuan from January 2014 to July 2018 were retrospectively analyzed.According to the onset to operation time, the patients were divided into four groups: group A (21 cases, the onset to surgery time was within 48 h), group B (26 cases, the onset to surgery time was 48-72 h), group C(19 cases, the onset to surgery time was>72 h-1 week), group D (16 cases, the onset to surgery time was more than 1 week). The operative time, intraoperative blood loss, conversion of abdominal cavity and complication rate were compared, and the risk factors of conversion to laparotomy were analyzed. Results The open abdominal rates of group A-D were 4.76%(1/21), 19.23%(5/26), 26.32%(5/19) and 18.75%(3/16), respectively.The rate of open abdomen in group C was the highest, which of group A was the lowest.There were statistically significant differences between group A and the other three groups (χ2=3.635, 4.181, 3.682, 3.552, 3.448, all P<0.05). Single factor analysis showed that the laparotomy was related to the enlargement of the gallbladder, the thickness of the gallbladder, and the time of operation (all P<0.05). The analysis of multiple factors showed that the thickness of the gallbladder wall more than 6 mm[OR=1.310 (95% CI: 0.681-1.264), P=0.001], the time of operation more than 48 h[OR=2.672 (95% CI: 0.261-0.961), and P=0.000] were independent risk factors for transabdominal surgery of acute cholecystitis laparoscopy. Conclusion Laparoscopic surgery within 48 hours of acute cholecystitis can reduce the risk of transabdominal surgery.The thickness of the gallbladder and the timing of the operation are independent risk factors affecting the transabdominal operation. Key words: Cholecystitis, acute; Cholecystectomy, laparoscopic; Operative timing; Factor analysis, statistical

Safety of laparoscopic subtotal cholecystectomy in acute cholecystitis. Experience in Southeast Mexico

IntroductionSubtotal cholecystectomy has been employed in cases of tecnically difficult cholecystectomy to prevent common bile duct injury. Given that there are few reports in Mexico on the theme, we consider it important to present the 18-year experience of a surgical group in the South-Southeast of Mexico. AimTo determine the safety of laparoscopic subtotal cholecystectomy in patients with acute cholecystitis. Materials and methodsA retrospective, observational, and comparative study was conducted on patients with gallstones that underwent laparoscopic cholecystectomy. The variables analyzed were: anthropometric characteristics, comorbidities, conversion rate, surgery duration, hospital stay, and morbidity and mortality. Statistical analysis: Descriptive statistics were applied through measures of central tendency and dispersion and standard deviation, utilizing the SPSS v22 program. ResultsA total of 1,101 medical records of patients with gallstones were reviewed. Of those patients, 223 presented with acute cholecystitis (20.25%) and they were divided into 2 groups: A) total cholecystectomy (82.95%) and B) subtotal cholecystectomy (17.05%). The anthropometric characteristics, risk factors, conversion rate, and hospital stay were similar in both groups. Only surgery duration was longer in the subtotal cholecystectomy group. Complications were more frequent, there was 1 death, and there was no bile duct injury in the subtotal cholecystectomy group. Those results were not statistically significant between the two groups. ConclusionsSubtotal cholecystectomy is a valuable resource in patients with acute cholecystitis. In our case series, it was a safe and reliable procedure for preventing bile duct injury. A larger number of cases are needed to corroborate those results.

An evaluation of early and delayed laparoscopic cholecystectomy for acute cholecystitis

Background: Acute cholecystitis is one of the hepatopancreatobiliary emergencies. With more and more experience in the laparoscopic cholecystectomy studies are being carried out evaluating the effectiveness and feasibility of early laparoscopic cholecystectomy in acute cholecystitis.Methods: Fifty patients presenting with acute cholecystitis were included in this study and randomized using chit in the box method into two groups- early group and delayed group.Results: Mean duration of surgery in the early group is 42.28±5.99 mins and in the delayed group is 39.12±5.55 mins (p=0.06). Gallbladder perforation was reported in 4 patients (16%) in early group and in 2 patients (8%) in delayed group (p=0.67). Gall stone spillage was reported in 3 patients (12%) in early group and in 2 patients (8%) in delayed group (p=1.00). At 6th hr mean VAS (visual analogue scale) score in the early group was 4.0±0.41 and in the delayed group it was 3.6±0.58 (p=0.01). At 12th hr mean VAS score in the early group was 3.4±0.51 and in the delayed group it was 3.3±0.48 (p=0.39). Mean duration of postoperative stay was 2.24±0.60 days in early group and in the delayed group it was 2.08±0.57 days (p=0.34).Conclusions: It has been found that early laparoscopic cholecystectomy is safe and feasible in the setting of acute cholecystitis with added advantage of shorter total hospital stay.

Hospital Enforcement of Early Cholecystectomy for Acute Cholecystitis

International guidelines state that early laparoscopic cholecystectomy (ELC) is appropriate for all severity grades of acute cholecystitis and leads to reduced hospital stays and costs. A multicenter prospective randomized controlled trial recommends ELC over delayed laparoscopic cholecystectomy (DLC) management because in addition to reduced hospital stays and costs, ELC also leads to reduced patient morbidity. Therefore, ELC is standard of care for acute cholecystitis. We hypothesize that 1) international guidelines are not presently followed and that 2) a quality improvement (QI) project enforcing ELC for acute cholecystitis will increase rates of ELC management. A retrospective chart review of all surgical consults for cholecystitis from January 2016 to December 2018 was undertaken. A total of 307 patients diagnosed with acute cholecystitis were included. ELC was defined as cholecystectomy within hospital admission. Pre-QI ELC versus DLC rates were 77.4 per cent (233/301) versus 22.6 per cent (68/301). Eight DLC patients (11.8%) returned to the ED after discharge secondary to persistent signs and symptoms of cholecystitis and 62.5 per cent (5/8) received an immediate cholecystectomy before their elective surgery date. After QI initiatives, ELC rates rose to 100 per cent (6/6). These data show there was a lack of consistent ELC management of acute cholecystitis.

Dementia in elderly patients undergoing early cholecystectomy for acute cholecystitis: a retrospective observational study

BackgroundDementia often adversely affects postoperative outcomes in surgical patients. This study evaluated postoperative outcomes among elderly patients with and without dementia undergoing early cholecystectomy for acute cholecystitis (AC).MethodsA total of 182 patients over 85 years of age who were diagnosed with AC and treated from January 2005 to March 2018 were reviewed retrospectively; 59 patients who underwent early cholecystectomy were enrolled. The complication rates, length of postoperative hospital stay, and rates of routine discharge (i.e., returning to their preoperative living location) were compared between two groups of patients with and without dementia.ResultsThe overall complication rate after early cholecystectomy for AC in 59 patients was 11.9%, and there was no mortality in this series. The median postoperative hospital stay was 9.0 days, and the routine discharge rate was 89.8%. Of the 59 patients, 22 patients (37.3%) had a history of dementia. Complication rates were comparable between the groups, despite the rate of delirium development being significantly higher in the dementia group. The median length of postoperative hospital stay and routine discharge rates did not significantly differ between groups.ConclusionsEarly cholecystectomy for patients with AC over 85 years of age was performed safely, and elderly patients with dementia had similar postoperative outcomes as compared with patients without dementia.

A prospective study on emergency laparoscopic or open cholecystectomy in acute cholecystitis in a tertiary care hospital

Background: Gallstones are among one of the most common diseases affecting the digestive system requiring hospitalisation with a prevalence of 11% to 36%. Until 2 decades ago, patients presenting with acute cholecystitis were treated conservatively and a delayed interval cholecystectomy was performed after 6 weeks, now a days laparoscopic cholecystectomy was gaining popularity in acute cholecystitis. It cannot be said with certainty preoperatively whether the cholecystectomy is going to be easy or difficult. The aim of the study was to evaluate safety and outcomes of emergency laparoscopic or open cholecystectomy in acute cholecystitis.Methods: This is a prospective, observational, single centre study conducted in the Department of General Surgery, S.V. Medical College/ SVRRGG hospital, Tirupati, for a period of one year from the time of approval of IEC. All patients undergoing emergency laparoscopic or open cholecystectomy for acute cholecystitis and its related complications are studied for various clinical, radiological and other variables.Results: Total 100 patients who presented with acute cholecystitis and undergone cholecystectomy are studied. Age, sex, BMI, comorbities, clinical and usg criteria and intra-operative findings and post-operative complications are analysed.Conclusions: Difficult dissection in cholecystectomy can be predicted using pre-operative parameters like increasing age, male gender, multiple attacks in the past, gallbladder wall thickness &gt;3 mm, and presence of pericholecystic fluid. Surgery performed within 72 hrs had good prognosis and few intra op complications due to good place of dissection due to inflammation.

Is it Safe to do Laparoscopic Cholecystectomy for Acute Cholecystitis up to Seven Days?

Is it Safe to do Laparoscopic Cholecystectomy for Acute Cholecystitis up to Seven Days?

A Comparative Study of Early Cholecystectomy and Interval Cholecystectomy in Acute Cholecystitis in a Tertiary Care Center

A Comparative Study of Early Cholecystectomy and Interval Cholecystectomy in Acute Cholecystitis in a Tertiary Care Center

Mo1419 – Security of Subtotal Laparoscopic Cholecystectomy in Acute Cholecystitis in the Southeastern Mexico

Mo1419 – Security of Subtotal Laparoscopic Cholecystectomy in Acute Cholecystitis in the Southeastern Mexico

Laparoscopic cholecystectomy for acute cholecystitis in a patient with left-sided gallbladder: a case report

BackgroundLeft-sided gallbladder is a relatively rare anatomical variation that is frequently associated with a biliary system anomaly. Here, we describe a case of left-sided gallbladder with acute cholecystitis treated by laparoscopic cholecystectomy.Case presentationAn 86-year-old man with acute upper abdominal pain was admitted to our hospital. Computed tomography demonstrated that the gallbladder was centrally dislocated and the wall enhancement was discontinued. Magnetic resonance cholangiopancreatography showed that the gallbladder wall was thickened and abnormally swollen. A laparoscopic cholecystectomy was performed. The round ligament was attached to the right side of the gallbladder, and the left-sided gallbladder was diagnosed by intraoperative findings. The patient was discharged 5 days after surgery without postoperative complications.ConclusionsA flexible and optimal port site should be inserted in cases of left-sided gallbladder with acute cholecystitis. An assessment of the extra- and intrahepatic biliary system is essential to avoid biliary injury in cases of left-sided gallbladder with acute cholecystitis.

Optimum timing of emergency cholecystectomy for acute cholecystitis in England: population-based cohort study

BackgroundCholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England.MethodsData from all consecutive patients undergoing surgery for acute cholecystitis on index admission in England from 1997 to 2012 were captured from the Hospital Episodes Statistics database. Data were analysed based on whether patients underwent surgery 0–3 days, 4–7 days or ≥ 8 days from admission. Outcome measures were rate of post-operative biliary complications, conversion to open and length of stay.ResultsForty-three thousand eight hundred and seventy patients underwent emergency cholecystectomy. 64.6% of patients underwent surgery between days 0 and 3 of admission, 24.3% between days 4–7 and 11.0% had surgery after day 8. Patients undergoing early surgery had significantly reduced rates of intra-operative laparoscopic conversion to open (0–3 days: 3.6%; 4–7 days: 4.0%; ≥ 8 days 4.7%, p = 0.001), post-operative ERCP (0–3 days: 1.1%; 4–7 days: 1.5%; ≥ 8 days 1.9%, p < 0.001) and bile duct injury (0–3 days: 0.6%; 4–7 days: 1.0%; ≥ 8 days 1.8%, p < 0.001). Early cholecystectomy was also associated with a shorter post-operative length of stay (LOS) [0–3 days group: median post-operative LOS 3 days (IQR: 1–6); 4–7 days group: 3 days (IQR 2–6); ≥ 8 days group: 4 days (IQR 2–9) (p < 0.001)]. High-volume centres undertook a significantly greater proportion of cholecystectomies within 3 days of presentation (high-volume: 67.3%; medium-volume: 64.8%; low-volume: 61.2%). In multivariate analysis greater time to surgery was independently associated with increased risk of post-operative ERCP and bile duct injury.ConclusionsEarly cholecystectomy within 3 days of admission reduces intra-operative conversion, post-operative biliary complications and length of stay. Centres undertaking the greatest numbers of emergency cholecystectomies perform a larger proportion within 3 days of admission.

A Comparative Study of Early Versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis and its Associated Complication

A Comparative Study of Early Versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis and its Associated Complication

A retrospective single-center study comparing clinical outcomes of 3-dimensional and 2-dimensional laparoscopic cholecystectomy in acute cholecystitis.

Backgrounds/AimsLaparoscopic cholecystectomy (LC) has become widely used and preferred standard treatment for gallbladder (GB) disease in many countries. In this study, we aimed to compare the overall clinical outcomes of 3-dimensional (3D) LC system with those of the 2D LC method.MethodsWe retrospectively analyzed patients who underwent LC for acute cholecystitis between January 2010 and March 2019 at the National Medical Center in Korea. We entered them into 3D LC (group A) and 2D LC (group B) groups. We used Olympus CLV-190 laparoscopic device with dual lenses, capable of displaying both 3D and 2D images. Postoperative variables considered for evaluating between-group differences in clinical outcomes included diet resumption period after surgery, postoperative hospital length-of-stay, outpatient department follow-up period, surgical time, and postoperative surgery-related complications (blood loss and open conversion).ResultsWe analyzed 278 acute cholecystitis patients (Group A, n=116; Group B, n=162). Compared to group B, group A had a significantly reduced surgical time and postoperative hospital stay. Although underlying diseases and abdominal surgical history were more prevalent in the 3D LC group, no significant between-group differences in blood loss and open conversion rate were observed.ConclusionsThe 3D imaging system offered many advantages over 2D LC, including reduced surgical time and shorter postoperative hospital stay; therefore, it has significance in reducing hospital costs.

Cholecystectomy for acute cholecystitis in octogenarians according to Tokyo guidelines 2013: our experience

Cholecystectomy for acute cholecystitis in octogenarians according to Tokyo guidelines 2013: our experience

Cholecystectomy for acute cholecystitis: our experience

Cholecystectomy for acute cholecystitis: our experience

Cholecystectomy for acute cholecystitis: our experience

Cholecystectomy for acute cholecystitis: our experience

Risk factors for difficult laparoscopic cholecystectomy in acute cholecystitis

Risk factors for difficult laparoscopic cholecystectomy in acute cholecystitis

Same-admission laparoscopic cholecystectomy in acute cholecystitis: the importance of 72 hours and oxidative stress markers.

This prospective randomized study aims to compare outcomes between immediate laparoscopic cholecystectomy (LC) and same admission delayed LC in patients with acute cholecystitis and also to investigate the relation between oxidative stress markers and complication rates in the patients with AC. This study included 64 patients with AC who were randomly divided into two groups. Patients in Group 1 (n=32) were immediately administered LC, while in Group 2 (n=32) patients underwent transient LC following medical treatment. All patients were operated on their first hospitalization. No statistically significant differences were observed between the groups for the comparison of complications, conversion rates, or operation durations (p>0.05). The length of postoperative hospital stay was found to be significantly shorter in group 1 compared to group 2 (1.75 vs 2.93 days; p=0.024). Only the total antioxidant status result was significantly higher in group 1 (p=0.017), but the finding was not correlated with complications. LC for AC was performed during the first admission was found to be safe, even beyond 72 hours following symptom onset. Pre-operative oxidative stress markers did not correlate with the complication rates.